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So, you went to have BOTOX to smooth away your forehead creases, but now they look too high and arched. What’s a girl to do?

Don’t sweat it. You have options.

An overly arched brow, often referred to as the ‘Dr. Spock’ brow, can be easily corrected. “This look is not necessarily due to an error on the part of the injector. The forehead and brow muscles can be very complex, which is why you should seek out an expert injector. The frontalis or forehead muscle is the only lifting muscle of the brows in the entire face. It is a balancing act of injecting the superior part of the forehead muscles to relax the lines and prevent a “peaked brow”, while not over injecting it to the point that a patient would have heavy feeling brows. Each patient is highly variable and requires a different amount of neuromodulator in the forehead in order to relax it and prevent it from pulling the brows up too high.” says Dr. Jason Bloom, a facial plastic surgeon in Ardmore, PA.

The good news is that correcting a rare spock brow typically involves just adding a little more BOTOX or Xeomin or Dysport, the three currently FDA approved variations of neuromodulators. “Although this is not a common occurrence, your injector may add a few units to the lateral forehead to slightly lower an overly arched brow. Once it is treated, it can be noted in your chart, so that the next time you get a treatment, your injector can follow that pattern to avoid any problems,” according to Dr. Bryan G. Forley, a plastic surgeon in New York City.

Among the many benefits of botulinum toxins is the predictability of results and simplicity of the treatment, in the right hands that is. Medicine is not an exact science, but it is going in that direction. TRUINJECT is one technology that aims to change the way injectors use fillers and toxins. The system offers something called a ‘Smart Syringe’ and ‘anatomical “Kate” platform’, which is a life-like model. The analytics offered help surgeons, doctors, nurse practitioners, and other healthcare providers to deliver injectable treatments with a higher level of accuracy and reproducibility. “TRUINJECT™ is a revolutionary technology that has proven to be a helpful tool that can be utilized by the novice and expert level injector alike,” says Dr. Bloom.

What’s next on the horizon?

New formulations of botulinum toxins are under development that are poised to expand the BOTOX market exponentially by offering consumers and practitioners more choices. There is a definite need for something that performs in a new and unique way. For example, longer lasting effects can offer a distinct advantage to overcome the obstacle of having to return to your doctor’s office every time the season changes.

The good news is that Revance Therapeutics is pretty far along with their development of RT002 or daxibotulinumtoxinA, a novel wrinkle relaxing drug that has been shown in clinical trials to have a longer duration of efficacy of up to 6 months. This may be available in the US as early as 2020. According to Miami plastic surgeon Jackie Yee, “RT002 has the potential to give patients a longer lasting benefit and to decrease the number of appointments a year from four visits to two to three visits per year. Having a longer lasting toxin is also sure to be attractive and beneficial to patients who are needle phobic or consider their injections to be uncomfortable.”

Among the other contenders, Evolushas a prabotulinumtoxinA 900 kilodalton (kDa) originally from Korea that is currently undergoing evaluation for approval by the US FDA, which may come on the market in the next year or less.

Finally, Bonti has an EB-001 botulinum neurotoxin serotype E (BoNT/E) from Bonti® has a fast onset of action (within 24 hours) and a short duration of effect (about 3 – 4 weeks), making it potentially suitable for pain management and for those who may want a quick fix without making a long-term commitment.